Trends

Babies are born every day but birthing is no everyday affair for a mum. In the rush to follow routine, this fact may be often overlooked.

Thankfully, the emergence of birthing centres in India could be a reason for mums to hope that their search for equality, respect and a sacred space to have a unique birth experience may be over at last…

Words Subarna Ghosh Visual Akshay Kulkarni

What’s a birthing centre?When mums go to the hospital to deliver a baby, they know what to expect from a medical facility. Starched uniforms, aprons, disposable gloves, a monitoring machine, the intravenous drip bottle hanger and smell of the disinfectant spirit welcomes her to labour. But the recent launch of natural birth centres aimed at reducing medical interventions and checking the C-section rates in India, has seen a slight change in this scenario. Imagine a mum-to-be and her partner walking into a homely bedroom with a sprawling double bed, bright curtains, a soothing vaporiser wafting a pleasant fragrance and soft music playing in the background. For company, they have a friendly midwife along with a doula or a Hypnobirthing expert ready to lend support so that birthing remains a gentle, natural and unique experience.

M&B expert and childbirth educator Sonali Shivlani defines a birthing centre more specifically when she says, “A birthing centre is a place where the woman births with the help of midwives. The ob/gyn is a backup option and is ideally called into the room only if the need arises. The labour team consists of trained midwives and doulas and the family as the support system.”

Kochi’s Birth VillageIn the small town of Kochi, childbirth educator Priyanka Idicula’s efforts have resulted in the setting up of the second free-standing birth centre of India, the first being the Birthing Centre in Assagao, Goa, run by German midwife Corrina and her husband. Named as ‘Birth Village’, the Kochi centre is well-known for the Lamaze-classes which have been conducted here since long. But being a part of the team that made Kerala’s first water birth possible gave Priyanka the final impetus to start a full-fledged birthing centre with the help of like-minded friends. Priyanka, who is training to become a midwife, says, “Birth Village truly follows the midwifery model of care, provides women with an option to choose how she wants to birth her baby and ensures that this choice is respected. It is possible that a day or two after the water bag breaks, the woman chooses to wait for her baby to arrive naturally as she is fully aware and capable of taking decisions. In the midwifery model of care, the responsibility is shared equally by the midwife and the mum so no one can take a decision on the mother’s behalf. However, the midwife is qualified to make recommendations and guide her. Birth cannot be a planned event so we must let the woman’s body find its own rhythm.”Priyanka believes that a birthing centre is built on the foundation of the relationship between the mum-to-be and her midwife which in turn is based on the principles of ‘equality, respect and sacred space’. But practical requirements also need to be looked into. For example, it is important that a hospital or medical centre is in the vicinity, easily reachable in about three minutes. In the Indian backdrop, it may be wise to register with a regular gynaecologist in advance, recommends Priyanka, so that in the case of an emergency, the doctor will not refuse care.Mumbai’s DaimaaThe birthing centres in Goa as well as Kochi are ideally located in beautiful, private bungalows that are surrounded by greenery. But such a space and setting often proves to be an unaffordable luxury when it comes to the big cities. Yet, the launch of Mumbai’s first birthing centre reinforces the belief that progressive change never fails to pave its way through the clutter of everyday routine. Daimaa’s Natural Birth & Wellness Centre is located in a 1,500-square-foot residential apartment in a busy suburban market area of Mumbai, a far cry from the serene setting that is ideal for housing a birthing centre. But what makes this a landmark are the founders, one of whom is a gynaecologist and obstetrician herself. Dr Veda and her husband Pravin Simons have handled resistance and ridicule, even from friends in the medical fraternity, in order to bring natural birth within the reach of the common Mumbaikar. The premises also house a medical facility, Dr Sherekar’s Hospital, that was established by Dr Veda’s mother, also a gynaecologist. Dr Veda and Pravin aimed to cut-down on travel time during emergencies when they decided to launch the birthing centre as a separate wing of the hospital. He explains, “We took utmost care so that the Operation Theatre would not be visible from the birthing rooms and tried to create a relaxing environment by doing up the interiors in a natural green colour scheme, using cheerful prints on the blinds, displaying wall art and equipping the rooms with a television, music, wardrobe and an extra pull-out bed.” Their efforts are visible, though the constraint of space is also an undeniable reality at this birthing centre that aims to resurrect the lost tradition of the Indian dai by providing necessary midwifery training to young women. Lamenting the poor quality of education and training given to nurses who specialise as midwives, this founder duo says that the natural birth movement cannot succeed until India starts producing competent midwives who will have the expertise to support a woman in labour with responsibility.

Dr Veda recalls that even before ‘Birth India’ – the network supporting natural birth in India – was formed, she found a new direction during a meeting with a Scottish midwife. “The righteousness of natural birth held great appeal and inspiration for me. I started asking questions to my own fraternity. The C-section rate of Dr Sherekar’s Hospital has always been very low. Only three to five out of 30 mums delivered through a C-section every month, so the idea of a birth centre was not really a very different reality for me,” she avers.

Services and costsKeeping in mind the importance of environment during birthing and the need to keep all medical interventions away, she decided to redesign and renovate the premises available so that the mum could have a gentle birth experience. It has only been two months since its launch and the first mum has already delivered through Hypnobirthing. Dr Veda reveals that the dearth of qualified Indian midwives mean that skilled foreigners have to step in to fill the gap. She says, “Though I am a doctor and am always present during the natural births, I am happy to have midwives and doulas to support the mum. Since we now house a birthing centre, we plan to close other gynaecological procedures and concentrate on safe births. We also have a neonatologist on stand-by during births.” The Mumbai-based birthing centre offers midwifery services that include services of an internationally-qualified midwife including antenatal home visits every month for up to six months, fortnightly till the eighth month and every week during the ninth month. The mum is checked by a gynaecologist if any parameters that may hinder the birth are noticed. Postnatal visits are also included.

Expenses incurred to have a baby in a birthing centre will obviously vary according to the city and the package that one opts for. In Kochi, Birth Village offers the mum Lamaze classes during the antenatal period and the package of Rs 35,000 includes the birth as well as these classes. If you skip the Lamaze classes, then you have to pay Rs 7,500 less. The service of an in-house midwife and a doula is included and so are the postnatal visits, lactation counselling and stay until you feel fit to go home. The set-up for a comfortable water birth is also available but Priyanka prefers not to design specific ‘packages’ for birthing as she feels that every woman has a unique experience and this cannot be slotted. In case, you want to birth at home, Priyanka is also willing to provide all facilities in the comfort of your own home. More aware of the importance of marketing, the Mumbai-based Daimaa’s presents an exhaustive list of services that include natural birthing, water birthing, hynobirthing, orgasmic birthing, Lamaze classes, yoga classes, nutritional guidance and mother and baby merchandise. It even has an ISO certification. Pravin, the CEO and MD informs that the package offered here costs Rs 65,000 and includes antenatal and postnatal care, lactation counselling, services of a paediatrician and nutritionist during stay, initial vaccination of the child and three to five days stay, including home-cooked food. In the case of an emergency where medical intervention is unavoidable, there will be OT charges and surgeon charges extra.

The whole spectrumThe principle of demand and supply works in the sphere of birth as well, we discovered. The awareness about the adverse effects of medicines used during hospital procedures like epidural or induction has created the demand for a more natural approach to birthing. Also the freedom to exercise one’s choice – the choice to wait, the choice of birthing position, the choice to eat or drink during labour, the choice of people as labour support – is denied to women in most traditional hospital set-ups. But mums want their choice to be respected and are willing to challenge the existence of institutions where there is no equality between the service providers like midwives or doctors and the receivers or mums-to-be.

Realising this change in the attitude of young parents-to-be, industry biggies like Apollo and Fortis have plunged into a new exercise in brand-building. They are offering expensive, five-star maternity centres called ‘birthing boutiques’. Dr Shaveta Sethi, Medical Superintendent at The Cradle, Gurgaon, says that they provide “a homelike facility, existing within a healthcare system with a programme of care designed in the wellness model of pregnancy and birth”. The Fortis Le Femme in Delhi is equipped with a luxury spa, a Swiss chocolate shop as well as diaper stations! They claim to be “driven by a core belief that a woman is a very special person, in body and mind, and that the best healthcare for her emerges from a deep understanding of her physiology, emotions, aspirations and anxieties”. While the concept of pampering mums sound great, none of them clearly reveal their C-section rates or talk about reducing medical intervention or promoting natural birthing.

The picture at the other end of the spectrum looks too bleak. Dr Veda reveals, “In municipal hospitals where we have trained as doctors, we saw how horribly women are treated during labour. They are verbally abused if they express discomfort and sometimes even physically forced to follow instructions given by the attending nurses. Nothing is a matter of choice for these mums.” Though upscale facilities are more pampering, the relationship between a doctor and ‘patient’ or mum-to-be still remains one where the doctor is in authority. In a birthing centre set-up, the idea is to empower the woman in labour.

Mums firstAnita Shetty, the first mum who delivered her baby at the Daimaa’s Natural Birth Centre through hypnobirthing, says that it was a very satisfying experience. She believed in birthing naturally and changed her doctor in the ninth month in order to be able to deliver in the newly-launched birthing centre. Priyanka Idicula says, “We may feel that natural birth is only for urban, upper class women. But this is a myth. The first mum who opted for my birthing centre was not a city girl. She had grown up in the hinterland. She is hardly fashionable and only wears a traditional Kerala saree but her roots are very strong. She believes in the natural way of living and could easily relate to what we are trying to achieve here.”

If the numbers of birthing centres grow, mums will finally be able to move beyond choosing between a restrictive hospital birth and a relatively unprepared home birth. Speaking of trends, Sonali reveals, “At present, none of my clients have opted for a home birth. In fact, very few have even opted for a doula, in spite of the fact that we actively provide the information about these optional supports available to mums.” She believes that birthing centres are definitely a viable option and some of the maternity nursing homes could function as birthing centres. But unfortunately, bringing the midwifery model of care back in a major hospital (as they have in the UK) seems like a distant future. Sonali hopes, “There is a good working relationship between the doctor, midwife and the doula with lines of communication running parallel. The ultimate objective of each of these services is to provide good service to the parents and ensuring the well-being of mother and baby. There is no place for ego in this equation, so they need to share parallel status.” M&B

Solitary trees, if they grow at all, grow strong. The same can be said of Andrea Newton, a young mother, aged 24, who is single-handedly bringing up her son Isaiah, 2.5 years. She shares with M&B her touching story of initial struggles, finding joys and pursuing dreams…

Present dayI work with Andrea in the same office. She’s stylish, a good looker with a carefree attitude. On most days, she keeps to herself but she’s friendly and I always sensed that she was good at heart. While we were shooting for her cover, we interacted a little more and I learnt that my first impression of her was not way off the mark at all. The tattoos around her neck, arms and ankle; the flower clip holding up her hair with a flourish, the prominent nose-ring and hip clothes, enhance her strong-willed and independent personality. But the sensitive woman within reveals herself while bonding with her precious son Isaiah. Those are the priceless moments in the life of Andrea Newton.

“I had morning sickness during the first trimester. But after that initial discomfort, I really enjoyed my pregnancy. I loved watching my belly grow and trying on maternity clothes!”

Young love“I met my ex-husband ‘R’ who is now deceased, when I had been to Dubai just after finishing college in Mumbai. My parents live there and I took up a job with a magazine. We met through common friends. At that time, R was 24 years old, working with an event management company. We dated six months before getting married. I was just out of college and very naive. He painted a happy picture, so I went along. He was the first person I knew in Dubai and we were always hanging out together. It seemed like a good decision at the time,” says Andrea sotto voce.

She continues in the same tone, “We then moved to Bengaluru, where I found a job with another music magazine. Four months later, I found out that I was expecting. It was around Christmas time in 2007. I was ecstatic about starting a family as I was lonely in a new city. Besides my work, I had nothing going for me. I thought the baby would be a perfect addition to our family. Initially, R was also very excited but as the pregnancy progressed, he realised the financial responsibilities that came with the situation and started feeling pressurised. We started quarrelling and it was mostly about his needs versus my needs,” she sighs.

In spite of their differences, Andrea recalls her pregnancy as being a terrific one. “I had morning sickness during the first trimester. But after that initial discomfort, I really enjoyed it. I loved watching my belly grow and trying on maternity clothes. Towards the end, I became a couch potato. In my first month, I was 52 kilos but by the last week of pregnancy, I had turned 73 kilos!” she confesses. With a reflective pause, Andrea shares her D-day experience: “It was August 16, 2008, at 10 pm when I went into labour. I remember there was a lunar eclipse that day. The doctors were asking me to push during contractions but I wasn’t listening to them. The pain felt weird. I was terrified and when the contractions came, I simply screamed.” The next day at three am, Isiah was born.

Falling ApartAndrea speaks about the aftermath when she went into a zombie-like state. “During the entire day, I hardly slept for more than two hours! Luckily at that time, my mum-in-law was staying with me. I would keep two feeds ready in the bottle for Iso, and go off to sleep so she could feed him.” While the birth of her child gave birth to her maternal instincts, her relationship with ‘R’ wasn’t shaping up. “He was excited at Iso’s birth but because our relationship had turned sour, he couldn’t really establish a fatherly bond with Iso. There was too much conflict of interest. Two months after Iso was born, I left home because our fights were getting out of hand. I didn’t want to be in that situation anymore,” she recalls. With her infant in tow, Andrea moved to Mumbai first and then to Jhansi with her grandparents. “I had no job, no money and I had nowhere else to go,” she shrugs.

While her struggles with her new life continued, her husband approached her for a patch-up. “He came to Jhansi and convinced me that we should give our marriage another shot. In the end, I relented. We decided to start a new life. We moved to Delhi and, for a while, things seemed to be better. Our fights weren’t that frequent. But soon we realised that we had grown apart because we were two different people. In 2009, we mutually separated. It was a good decision because Iso was growing and it wouldn’t be good for him to see his parents fighting all the time. I couldn’t function as a person. I felt I would rather be alone than in a marriage that wasn’t working,” she says, with no trace of bitterness.

Finding supportHer sheer determination alone could have brought her this far but Andrea also gives credit to her family and her friends, who stood by her through thick and thin. “My parents have been in Dubai and I haven’t seen them for a year now and I hadn’t seen them prior to 2007. They were concerned but I couldn’t actually communicate to them what was happening through the phone or via e-mail. They were supportive throughout as they knew what was happening. I left because I didn’t want my son growing up in that environment. I could not be in a relationship where my husband didn’t respect me and I didn’t want my son growing up not learning to respect women,” she asserts.

An old college mate of Andrea’s got in touch with her during that period. “She was getting married and when she heard my side of the story, she decided to help me. She put me up with her parents in Delhi and they were a big help. Before my 23rd birthday, she took me to Dharamsala on holiday. I loved the place and decided to stay back. I was at peace. I did some freelance writing for about three months. But then I wasn’t making enough money and I realised that Iso would need to go to school, so I shifted back to Mumbai before he turned one. I had a good network of friends in Mumbai as I had studied here. A lot of them helped me pull through during the rough period,” she narrates.

“He’s always been a peaceful baby. After seven months, he slept through the night. He rarely fell sick. He’s never been cranky…”

In some time, Andrea was able to grow more independent. “I found a studio apartment in Malad and got a good babysitter for Iso. I got a job as a real estate marketing manager. I had to wear formal

clothes and meet corporates. I worked like that for a month and soon realised it wasn’t for me. I quit that job as soon as I landed my current job with Next Gen Publishing’s Ideal Home & Garden magazine. Once I started working here, it opened up new alleys creatively. I have more time to design clothes, something that interests me. After a while, I moved to another Mumbai suburb – Bandra. I like it here and it is convenient for me to travel. Most of my friends stay in Bandra so there’s always someone I can call in case I need help,” says the young mum, who is now well placed.

Andrea’s parents, however, would like her to move back to Dubai. “They want me to come back but I am in two minds. I have started designing clothes and it will take time to make my foundation. But if I stick to it, I know it will happen. Dubai is a nice place to holiday in but I couldn’t live there. I like the energy of Mumbai city. Sometimes, it does get stressful but on most days, it’s nice,” she muses.

Another reason is because she values her independence way too much. She explains, “I enjoy being independent and making my own decisions. I feel I might not be able to do that when I live with my parents. They will be telling me how to raise Iso and so on. Financially, it is hard for me to live in this city, but I can live by my rules and raise Iso the way I want. I like what I’m doing now but eventually, I would like to have my own design studio and workshop where I can make my own clothes and sell them. That would be my ideal way to make money,” she admits.

Raising IsaiahAndrea is all praise for her little son. He’s always been a peaceful baby. After seven months, he slept through the night. He rarely fell sick. He’s never been cranky. “Of late, I notice the temper tantrums, but then that’s what they say about the terrible twos,” she adds with a grin. She rattles off Iso’s schedule: “He spends time in a crèche with another baby while I’m at work. In the evenings, I take him to the promenade and play with him. He enjoys painting and he can sit for hours with crayons and paper. We eat breakfast and dinner together, watch a cartoon and then go off to bed. I spend one hour of quality time with him in the morning before taking him to the babysitter. In a couple of months, I’ll start him in playschool. I know I’ll have to make sacrifices on my part. Presently, I also do freelance work to supplement my work.” Andrea reveals her ex-husband passed away last year due to a cardiac arrest. “It was unexpected. I received a call from his friend informing me that he was no more. I still don’t know what exactly caused the attack,” she says. Does Iso miss his dad? She answers, “Iso has no recollection of his dad. He is too young to understand. I will tell him when he’s older.” And does Andrea feel like ever getting married again? “Eventually, if the right person came along, I would…” she sums up with a whole-hearted laugh. M&B